Why Now? How Low Ferritin Finally Catches Up with Us in “Perimenopause”

Ya’ll, I don’t care if I sound like a conspiracy theorist. My mind is blown and I want everyone to know what I know.

If you have hair loss, brain fog, anxiety, and your period is getting worse, but your hormones remain “normal,” there is something I need you to do:

Go to the doctor and get your ferritin checked.

What’s ferritin, you might ask?

Ferritin is a protein that stores iron in the body and releases it when needed. It acts as the primary iron reserve, ensuring a steady supply for essential functions like oxygen transport, energy production, and immune support. Ferritin is primarily stored in the liver, spleen, and bone marrow, and small amounts circulate in the blood, which can be measured through a ferritin blood test.

Why Does Ferritin Matter?

1. Iron Storage & Oxygen Transport

   • Ferritin helps maintain adequate iron levels, which are essential for producing hemoglobin—the protein in red blood cells that carries oxygen.
   • Low ferritin means the body may not have enough iron to support oxygen transport, leading to fatigue and weakness.

2. Energy Levels & Cognitive Function

   • Low ferritin is a major cause of chronic fatigue, even if hemoglobin levels are normal.
   • Iron plays a role in brain function, and deficiency can lead to brain fog, poor concentration, and memory problems.

3. Hair Growth & Skin Health

   • Ferritin is crucial for hair follicle growth, and low ferritin (<50 ng/mL) has been linked to hair thinning and excessive shedding (telogen effluvium).
   • Iron also contributes to healthy skin by aiding in collagen production.

4. Immune System Support

   • Iron stored in ferritin is needed for the production of immune cells, helping the body fight infections effectively.

5. Restless Leg Syndrome (RLS)

   • Studies show that low ferritin levels (especially <50 ng/mL) can contribute to RLS, causing uncomfortable leg sensations and disrupted sleep.

Ideal Ferritin Levels

• Below 30 ng/mL → Iron deficiency, likely causing fatigue and other symptoms.
• 30-50 ng/mL → Borderline low, possible symptoms like hair loss and brain fog.
• 50-100 ng/mL → Optimal for most women to avoid symptoms.
• 100-200 ng/mL → Good reserves but should be monitored for iron overload risks.

Why Women Struggle with Ferritin Levels

Women frequently experience low ferritin due to:

• Menstruation (monthly iron loss)
• Pregnancy & breastfeeding (high iron demand)
• Low dietary intake of heme iron (from meat)
• Gut absorption issues (from conditions like low stomach acid, celiac disease, or IBS)

Maintaining ferritin above 50 ng/mL is essential for overall well-being, preventing fatigue, cognitive issues, hair loss, and immune dysfunction. If you’re experiencing any of these symptoms, a ferritin blood test can help determine whether iron deficiency is a factor.

Why Does it Suddenly Catch Up with Us in Our 40s and 50s?  Is It Perimenopause or just a ferritin crisis?

Why Does Low Ferritin Get Worse During Perimenopause?

Perimenopause—the transition phase before menopause—can dramatically worsen ferritin depletion due to a combination of hormonal shifts, increased blood loss, and absorption issues. Here’s why ferritin levels tend to crash during perimenopause, making symptoms like fatigue, hair loss, and brain fog even worse.

1. Heavy & Irregular Periods = Increased Blood Loss

• Perimenopause often causes heavier, prolonged, or irregular menstrual cycles.
• Some women experience flooding periods, clotting, or back-to-back cycles—leading to massive iron loss.
• If ferritin is already low (which is common in menstruating women), this accelerates depletion.

2. Hormonal Changes Disrupt Iron Absorption

• Estrogen fluctuations affect stomach acid production, reducing iron absorption in the gut.
• Progesterone drops lead to gut motility issues, sometimes worsening digestive problems like low stomach acid or inflammation—further impairing iron uptake.
• If you already have gut conditions like IBS, SIBO, or H. pylori, perimenopause exacerbates malabsorption.

3. Increased Inflammation Depletes Ferritin Faster

• Estrogen has anti-inflammatory properties, and as it declines in perimenopause, inflammation increases.
• Chronic inflammation blocks iron absorption and increases ferritin breakdown, leading to lower reserves.
• Conditions like autoimmune disorders, joint pain, and gut inflammation often flare up, making iron management even harder.

4. Increased Iron Needs for Brain & Energy

• Iron is essential for dopamine production and neurotransmitter balance.
• Brain fog, mood swings, and memory issues in perimenopause are partially linked to low iron stores.
• As energy levels fluctuate wildly during perimenopause, the body demands more iron to keep up—but isn’t getting enough.

5. Hair Loss Becomes More Noticeable

• Ferritin below 50 ng/mL is a major trigger for excessive hair shedding (telogen effluvium).
• During perimenopause, estrogen drops cause hair follicles to become more sensitive to low ferritin.
• Women who never had hair loss before perimenopause suddenly experience thinning, often mistakenly blaming hormones alone.

6. Poor Sleep & Restless Legs Drain Ferritin Further

• Restless leg syndrome (RLS) is strongly linked to low ferritin (<50 ng/mL) and often worsens in perimenopause.
• Low iron impacts dopamine, which plays a role in sleep regulation—making insomnia worse.
• Sleep deprivation reduces the body’s ability to absorb and store iron, creating a vicious cycle.